Healthcare Provider Details

I. General information

NPI: 1740176767
Provider Name (Legal Business Name): LINDA GISELLE TAMAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

7309 GANACHE WAY
SACRAMENTO CA
95829-8602
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-3284
  • Fax:
Mailing address:
  • Phone: 209-499-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: